Medical Use Of Prescription Opioids Research Articles

Understanding “Access” and “Excess”: A Secondary Data Analysis to Describe Prescription Opioid Medication Use and Potential Harms for Patients with Cancer in Rural Southwest Virginia (FR481D)

Understanding “Access” and “Excess”: A Secondary Data Analysis to Describe Prescription Opioid Medication Use and Potential Harms for Patients with Cancer in Rural Southwest Virginia (FR481D)

Energy drinks and energy shot use associated with non- medical prescription opioid use among adolescents

We investigated the relationship between energy drinks (ED), energy shot (ES) and non-medicalopioid use among high school students. Logistic regression indicated ED use was a significant predictor ofnon-medical Vicodin (OR = 1.314, P < 0.05) use but not non-medical Oxycontin use (OR = 1.050 P= 0.073) and ES use was a statistically significant predictor of non-medical use of Vicodin (OR = 1.545,P < 0.01) and Oxycontin use (OR = 1.590 P < 0.001). Mann-Whitney U tests indicated significantlygreater non-medical opioid use among students who used ED and ES than those who did not.

Most nonmedical users of Rx drugs started with medical use, use them for pain relief: Study

Both medical and nonmedical (misuse or abuse) use of prescription opioids have been declining among adolescents, according to a study published in the April 2017 issue of Pediatrics. However, prescription opioid exposure is still common, with adolescents who reported both medical and nonmedical use more likely to have started with medical use. Medical use of prescription opioids among teens peaked in 1989 and 2002 and stayed level until a decline that began in 2013.

Nonmedical Use of Prescription Opioids among Pregnant U.S. Women

ObjectivesNonmedical use of opioids during pregnancy is associated with adverse outcomes for women and infants, making it a prominent target for prevention and identification. Using a nationally representative sample, we determined characteristics of U.S. pregnant women who reported prescription opioid misuse in the past year or during the past month. MethodsWe used data from the National Survey on Drug Use and Health (2005–2014) in a retrospective analysis. The sample included 8,721 (weighted n = 23,855,041) noninstitutionalized women, ages 12 to 44, who reported being pregnant when surveyed. Outcomes were nonmedical use of prescription opioid medications during the past 12 months and during the past 30 days. Multivariable logistic regression models were created to determine correlates of nonmedical opioid use after accounting for potential confounding variables. ResultsAmong pregnant women in the United States, 5.1% reported nonmedical opioid use in the past year. In adjusted models, depression or anxiety in the past year was strongly associated with past year nonmedical use (adjusted odd ratio [AOR], 2.15; 95% CI, 1.52–3.04), as were past year use of alcohol (AOR, 1.56; 95% CI, 1.11–2.17), tobacco (AOR, 1.72; 95% CI, 1.17–2.53), and marijuana (AOR, 3.44; 95% CI, 2.47–4.81). Additionally, 0.9% of U.S. pregnant women reported nonmedical opioid use in the past month. Past year depression or anxiety and past month use of alcohol, tobacco, and marijuana each independently predicted past month nonmedical use. ConclusionsCharacteristics associated with nonmedical opioid use by pregnant women reveal populations with mental illness and co-occurring substance use. Policy and prevention efforts to improve screening and treatment could focus on the at-risk populations identified in this study.

Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976-2015.

Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015. The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids. Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use. Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.

Revisiting the 'paradigm shift' in opioid use: Developments and implications 10years later.

A decade ago, we queried the unfolding of a 'paradigm shift' in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use-related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system-based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited-including those to reduce medical PO use to levels supported by best evidence for pain care. At the same time, heroin use has been increasing again, now commonly tied into interdependent opioid use trajectories, initiated with POs yet shifting to heroin as influenced by economic or availability factors. For policy, there are now two major and urgent-yet partly conflicting-tasks: one is to reduce the determinants of PO misuse and harms by reducing medical prescribing to levels supported by good evidence, while the other is to effectively protect those many active problematic PO users from acute harms (including overdose mortality) by providing effective treatment and survival aids (e.g. naloxone). Surprisingly, it appears that a major 'homemade' and medical system-induced drug crisis has been at least as challenging for North American policy systems to address as other, more conventional illicit drug problems. Lessons for policy hence need to be urgently identified and applied for the future. [Fischer B, Rehm J. Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later. Drug Alcohol Rev 2017;00:000-000].

High levels of self-reported prescription opioid use by HIV-positive individuals

ABSTRACTPrescription medication use (other than antiretroviral therapy (ART)) is highly prevalent among people living with HIV. Prescription medications may be used medically or non-medically: non-medical use includes using more medication than prescribed, using medication prescribed to someone else, or using medication for a purpose other than its prescribed use. During 12 weeks in 2014–2015, we characterized medical and non-medical prescription medication use among HIV-positive patients attending an academic medical center (n = 149) and a community clinic (n = 105). Separately for the past year and the past month, these 254 participants self-reported their use of prescription opioids, sedatives, stimulants, anti-anxiety medications, antipsychotic medications, and erectile dysfunction medications. Respondents were largely male (91%), aged 40 or older (61%), identified as gay or bisexual (79%), and were men who have sex with men (85%). ART use was nearly universal (95%). Nearly half (43%) of participants reported medical use of prescription opioids; 11% of the opioid use was reported as non-medical use. Anti-anxiety medication use was also frequent, and differed by site: 41% of community-clinic responders reported medical use of anti-anxiety medications compared to 23% of hospital clinic respondents who reported medical use. Prescription sedative use was also approximately twice as high among community-clinic participants, with medical use reported by 43% of respondents and non-medical use by 12%; in comparison, at the hospital clinic, sedative use was reported by 18% (medical) and 7% (non-medical) of participants. Stimulant use was rare in both sites. No demographic characteristic was significantly associated with medical or non-medical use of any prescription medication. The current focus of many studies on only non-medical prescription medication use not only underestimates the widespread exposure of HIV-positive individuals to these drugs, but may also underestimate potential adverse effects of prescription medications in this population.

Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study.

The objective of this study was to examine the association of context of prescription opioid exposure (ie, medical or nonmedical) in adolescence with the subsequent risk of nonmedical use of prescription opioids (NMUPO) and substance use disorder (SUD) symptoms at age 35. Multiple cohorts of nationally representative probability samples of U.S. high school seniors (n = 4072) were surveyed through self-administered questionnaires and followed longitudinally from adolescence (modal age 18, graduating classes 1976-1996) to age 35 (1993-2013). Main outcome measures were past-year NMUPO and SUD symptoms. The medical and NMUPO during adolescence was significantly associated with NMUPO at age 35. Relative to no prescription opioid exposure, medical use of prescription opioids without any history of NMUPO during adolescence was not associated with SUD symptoms at age 35. In contrast, compared with no prescription opioid exposure during adolescence, the adjusted odds ratios (AORs) associated with SUD symptoms at age 35 were greater among those with a history of both medical use of prescription opioids and NMUPO during adolescence, AOR = 1.49 (95% CI = 1.13-1.97); and among those who reported NMUPO only, AOR = 2.61 (95% CI = 1.88-3.61). The findings indicate medical use of prescription opioids without any history of NMUPO in adolescence is not associated with SUD symptoms at age 35, whereas any NMUPO in adolescence predicts SUD symptoms at age 35. Screening instruments and preventive intervention programs to reduce NMUPO and SUDs must account for the context associated with prescription opioid exposure during adolescence.

Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines.

Opioid poisonings have increased as use of prescription opioid medications have increased. To reduce these poisonings, guidelines for chronic opioid use have been implemented. However, if opioid poisonings occur in individuals who do not have high prescribed doses and who are not chronic opioid users, the current guidelines may need revision. To examine changes in rates of methadone and other opioid poisonings after implementation of the WA State Opioid Guideline in 2007 and to examine the prescription history before poisonings. The study sample consisted of individuals who had at least 1 paid claim for an opioid prescription in the Medicaid fee-for-service system between April 2006 and December 2010 and had an emergency department or inpatient hospital claim for an opioid poisoning. Methadone poisonings occurred at 10 times the rate of other prescription opioid poisonings and increased between 2006 and 2010. Rates of other prescription opioid poisonings appeared to level off after implementation of the WA opioid guideline in 2007. Among individuals with nonmethadone opioid poisonings, only 44% had chronic opioid use, 17% had prescribed doses in the week before the poisoning >120 mg/d morphine-equivalent dose (MED), 28% had doses <50 mg/d MED, and 48% had concurrent sedative prescriptions. It may be prudent to revise guidelines to address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use. Research is needed to establish the best strategies to prevent opioid poisonings.

The Misuse of Prescription Opioids: A Threat for Europe?

In the the past two decades the medical use of prescription opioids (POs), in particular oxycodone, increased up to 14-fold in the U.S. and Canada. The high consumption of these pain relievers also led to non-medical use and abuse of these substances which in turn resulted in a dramatic increase in the number of PO related fatalities and opioid dependent subjects. In the U.S. POs became the second most prevalent type of abused drug (4.5 million abusers; 1.7% of the population) after marijuana (8 million abusers) with currently 1.9 million (0.7% of the population) people dependent on opioid pain relievers. Pain relief was the leading motive for non-medical use in about 40% of the cases, but about half of non-medical PO users reported non-pain relief motives only, like to get high or to relax. Since 2011, there is a decline in the use and misuse of POs and reduction in painkiller overdose deaths in the U.S. probably due to the introduction of a variety of restrictive regulations. In Europe, the medical use of POs is increasing as well, but at a much slower rate than in the U.S. Moreover, in Europe non-medical use of POs and fatal PO incidents are (still) rare. The paper highlights and discusses the differences between Europe versus U.S. and Canada in an attempt to assess the risk of a PO abuse and overdose epidemic in Europe. It is concluded that the risk in Europe seems to be rather limited but vigilance is needed.

Trends in Opioid Analgesic Abuse and Mortality in the United States

BackgroundThe use of prescription opioid medications has increased greatly in the United States during the past two decades; in 2010, there were 16,651 opioid-related deaths. In response, hundreds of federal, state, and local interventions have been implemented. We describe trends in the diversion and abuse of prescription opioid analgesics using data through 2013.MethodsWe used five programs from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System to describe trends between 2002 and 2013 in the diversion and abuse of all products and formulations of six prescription opioid analgesics: oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol. The programs gather data from drug-diversion investigators, poison centers, substance-abuse treatment centers, and college students.ResultsPrescriptions for opioid analgesics increased substantially from 2002 through 2010 in the United States but then decreased slightly from 2011 through 2013. In general, RADARS System programs reported large increases in the rates of opioid diversion and abuse from 2002 to 2010, but then the rates flattened or decreased from 2011 through 2013. The rate of opioid-related deaths rose and fell in a similar pattern. Reported nonmedical use did not change significantly among college students.ConclusionsPostmarketing surveillance indicates that the diversion and abuse of prescription opioid medications increased between 2002 and 2010 and plateaued or decreased between 2011 and 2013. These findings suggest that the United States may be making progress in controlling the abuse of opioid analgesics. (Funded by the Denver Health and Hospital Authority.)

Opioid Use Among Interscholastic Sports Participants: An Exploratory Study From a Sample of College Students

Purpose: Involvement in sports increases the risk for injury and the risk for prescription opioid use and misuse. This was an exploratory retrospective study to examine if previous involvement in interscholastic sports was associated with a greater lifetime prevalence of medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use. Method: A Web-based survey was self-administered to a sample of 4,187 full-time undergraduate students at a large public university located in the Midwest. Student demographics, involvement in interscholastic sports during high school, lifetime medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use were measured and analyzed for this study. Results: Multiple logistic regression analyses indicated that those who participated in at least 1 interscholastic sport during high school had greater odds for lifetime medical prescription opioid use on multiple occasions and greater odds for being approached to divert their prescribed opioid medications on multiple occasions when compared with their peers who did not participate in interscholastic sports during high school. Conclusions: The findings indicate some association between previous involvement in interscholastic sports and prescription opioid use and misuse. These findings further suggest that greater awareness should be instilled in parents and coaches regarding this form of substance misuse.

Prescription opioid abuse and tampering in the United States: results of a self-report survey.

The objective of this study is to estimate the prevalence and impact of prescription opioid abuse and tampering among US adults. Participants from the US National Health and Wellness Survey were invited to complete an online survey assessing use, misuse, and abuse of prescription opioid medications in the preceding 3 months. A total of 25,864 adults were screened for self-reported opioid abuse. Prevalence was calculated using weights based on age, gender, race, and education. Respondents reporting abuse or medical use of prescription opioid medication in the prior 3 months (N = 1,242) completed a questionnaire assessing health care resource use and the Work Productivity and Activity Impairment questionnaire. The prevalence of prescription opioid abuse in the 3 months prior to the survey was estimated at 1.31% of US adults, with approximately half (0.67%) tampering during that time. Opioid abuse increased with younger age, male sex, minority race, psychiatric illness, alcoholism, cigarette smoking, being employed, and higher household income. Respondents abusing opioid medications reported greater impairment in work and nonwork activities and more health care use than nonusers. Tampering with opioid medication was associated with greater productivity loss and increased use of health care (all P < 0.05). Tampering with opioid medications to get high is associated with substantial loss of productivity and health care use. Technologies that reduce users' ability to tamper may reduce the burden of opioid abuse on the health care system.

Motives for Medical Misuse of Prescription Opioids Among Adolescents

This study examined the motives for medical misuse of prescription opioids among adolescents and assessed differences in motives by demographic characteristics, substance abuse, and diversion behaviors. A survey was conducted in 2011 to 2012 and the sample consisted of 2,964 adolescents (51% female). Thirteen percent reported past-year medical use of prescription opioids. Among those prescribed opioids in the past year (n = 393), 17.9% reported medical misuse (eg, using too much, using to get high, or using to increase alcohol or other drug effects). The most prevalent motives for medical misuse were “to relieve pain” (84.2%) and “to get high” (35.1%). Multivariate analyses indicated that the motives differed by race, and that different motives were associated with different substance abuse and diversion behaviors. The odds of past-year substance abuse among medical misusers motivated by non–pain relief were more than 15 times greater than for nonusers (adjusted odds ratio = 15.2, 95% CI = 6.4–36.2, P < .001). No such differences existed between nonusers and appropriate medical users, or between nonusers and medical misusers motivated by pain relief only. These findings improve our understanding of opioid medication misuse among adolescents and indicate the need for enhanced education about appropriate medical use, pain management, and patient communication with prescribers. PerspectiveThis article represents the first investigation to examine the motives associated with medical misuse of prescription opioids among adolescents. The results indicate that the majority of medical misuse is associated with pain relief. This information could be used to develop strategies to reduce opioid medication misuse among adolescents.

Medical use, medical misuse, and nonmedical use of prescription opioids: Results from a longitudinal study

The objective of this study was to examine the prevalence and patterns associated with past-year medical use, medical misuse, and nonmedical use of prescription opioids (NMUPO) among adolescents over a 2-year time period and to examine substance abuse, sleeping problems, and physical pain symptoms associated with these patterns of medical use, medical misuse, and NMUPO. A Web-based survey was self-administered by a longitudinal sample of 2050 middle and high school students in 2009–2010 (Year 1) and again in 2010–2011 (Year 2). The study was set in 2 southeastern Michigan school districts. The longitudinal sample consisted of 50% females, 67% Whites, 28% African-Americans, and 5% from other racial/ethnic categories. Main outcome measures were past-year medical use, medical misuse, and NMUPO. Of those reporting appropriate medical use of prescription opioids in Year 1, approximately 34% continued medical use in Year 2. Of those reporting past-year NMUPO in Year 1, approximately 25% continued NMUPO in Year 2. Appropriate medical use and NMUPO for pain relief was more prevalent among girls than boys. Multiple logistic regression analyses indicated that the odds of a positive screen for substance abuse in Year 2 were greater for adolescents who reported medical misuse or NMUPO for non-pain-relief motives in Year 1 compared with those who did not use prescription opioids. The findings indicate an increased risk for substance abuse among adolescents who report medical misuse or NMUPO for non-pain-relief motives over time. The findings have important clinical implications for interventions to reduce medical misuse and NMUPO among adolescents.

Non-Analgesic Effects of Opioids: Factors Relevant to Opioid Abuse and Abuse- Deterrent Formulations

Abuse-deterrent opioid formulations are receiving renewed interest in light of the increasing legitimate medical use of prescription opioids for the adequate treatment of pain. Unfortunately, there is an inevitable associated potential for misuse, diversion, and abuse. The challenges of deterrence are significant: opioid abusers are a heterogeneous population; studies on drug "liking" and opioid "attractiveness" are informative, but mainly rely on reports from users who are not reliable respondents; drug "liking" scores are useful, but it is unclear how much drug "liking" must be reduced in order to achieve an actual reduction in abuse levels; and the most popular drugs among opioid abusers appear to be those that meet a complex combination of both positive and negative criteria including things like availability, pricing, and how easily the drug's illicit use can be concealed. Several abuse-deterrent formulations have been introduced or are in development. Epidemiological studies will have to be conducted to evaluate their effectiveness. Although there are currently more questions than answers, such products are clearly of medical and societal importance.

Medical and Nonmedical Use of Prescription Opioids Among High School Seniors in the United States

OBJECTIVES To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States and to assess substance use behaviors based on medical and nonmedical use of prescription opioids. DESIGN Nationally representative samples of high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING Data were collected in public and private high schools. PARTICIPANTS The sample consisted of 7374 students from 3 independent cohorts (2007, 2008, and 2009). OUTCOME MEASURES Self-reports of medical and nonmedical use of prescription opioids and other substance use. RESULTS An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Sex differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. More than 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. CONCLUSIONS Nearly 1 in every 4 high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication.

Use of Prescription Opioid Medication among Community-Dwelling Older Adults with Noncancer Chronic Pain

Research exploring the use of prescription opioid medications among community-dwelling older adults is lacking within the current body of health related literature. Previous studies on prescription opioid use have focused on misuse among young and middle-aged adults. The purpose of this pilot study was to: (1) describe older adults' patterns of adherence to their prescription opioid medication regimens and their reasons for these medication use patterns; and (2) examine the associations between adherence of prescription opioids, pain intensity, and pain interference on daily activity. This study utilized a cross-sectional design. Twenty-one participants aged 65 years and older with non-cancer chronic pain were recruited for this study. Findings revealed that almost half of the study participants reported taking less prescription opioids than prescribed, with 2 participants taking more than the recommended dose. There was no significant association between prescription opioid medication adherence and pain ...

Somatization is Associated With Non-Adherence to Opioid Prescriptions

Non-adherence to opioid prescriptions can decrease the safety and efficacy of opioid therapy. Identifying factors associated with over- and under-use of opioids in patients presenting with pain may improve prescribing and pain management. Patients presenting with pain often also present with somatization, and somatization is associated with both excessive use of and non-adherence to medications. This study examines the relationship between somatization and non-adherence (over- and under-use) to opioid prescriptions in the Veteran sample. One hundred and ninety-one Veterans who received an opioid prescription at a Veterans Affairs Palo Alto Health Care System in the prior year participated by completing a 1.5 hour semistructured interview which included assessments of depressive symptoms, somatization, medication side effects, and opioid pain medication usage. The percentage of patients non-adherent to opioid prescriptions increased as a function of somatization: Compared to no somatization, all levels of somatization were associated with higher rates of underuse, while severe somatization was associated with increased rates of overuse. Consistent with previous studies of medication non-adherence, increased depression and medication side effects were associated with decreased adherence to opioid prescriptions. However, in exploratory analyses, somatization mediated the relationship between depressive symptoms and opioid-use patterns as well as medication side effects and opioid use patterns. PerspectiveThis article sought to explore the relationship between somatization and adherence to prescription opioid medications. Our findings suggest that pain management treatment plans may be optimized by addressing patient distress about physical symptoms when considering the use of prescription opioid medications.

Connecting to Young Adults: An Online Social Network Survey of Beliefs and Attitudes Associated With Prescription Opioid Misuse Among College Students

A survey of motives and attitudes associated with patterns of nonmedical prescription opioid medication use among college students was conducted on Facebook, a popular online social networking Web site. Response metrics for a 2-week random advertisement post, targeting students who had misused prescription medications, surpassed typical benchmarks for online marketing campaigns and yielded 527 valid surveys. Respondent characteristics, substance use patterns, and use motives were consistent with other surveys of prescription opioid use among college populations. Results support the potential of online social networks to serve as powerful vehicles to connect with college-aged populations about their drug use. Limitations of the study are noted.